Gender Affirming Care and IBD
Gender Affirming Care is a spectrum and all depends on your journey as a transgender and/or gender non-binary individual - from surgical affirmation to hormonal therapy, don’t let IBD prevent you from becoming your best self.
Gender Affirming Hormone Therapy and IBD
Busting myths about HRT and IBD, what to expect when starting HRT with IBD, and navigating ‘Transgender Broken Arm Syndrome’
GAHRT (Gender Affirming Hormone Replacement Therapy) is used by some transgender individuals who wish to transition medically. This includes, but is not limited to, Testosterone ( Testosterone Cypionate or Proprionate SubQ Injection, Intramuscular Injection, Nebido Pellet, Testogel, and Patches) Estrogen, Estradiol, Progesterone, GnRH antagonists/puberty blockers, spironolactone, and more.
Transgender Broken Arm Syndrome is the phenomenon of healthcare providers misattributing symptoms of disease to your HRT or gender identity - in this case, that may look like a flare being blamed/attributed to your HRT.There is limited research on transgender IBD patient health, however, testosterone replacement therapy has been shown to decrease CRP and pro-inflammatory cytokines (doi: 10.1515/hmbci-2015-0014)
In transgender men without IBD, gender-affirming hormone therapy led to a decrease in CRP and blood pressure (doi:10.1002/ajhb.22203)
Patients with active IBD and those who received testosterone were more likely to experience a flare.
A 2024 study at Johns Hopkins showed that GAHT was not associated with increased incidence of flares however (doi: 10.1093/ibd/izae236.)
It is important to talk to your healthcare team about what matters most to you. Stress and anxiety associated with gender dysphoria can contribute to overall distress that compounds flares, so these are multifaceted decisions.
Talk to your GI doctor and endocrinologist (or prescribing provider of HRT) about your specific situation - not all IBD experiences are the same as not all TGNC experiences are the same.
Gender Affirming Surgery and IBD
As always, this will be specific to your IBD and transition journey and requires a conversation with your gastroenterologist, colorectal surgeon, and gender-affirming surgeon.For individuals with fistulizing disease (Perianal, rectal, and preexisting pelvic floor disorders (eg, Crohn’s disease, prior radiation, prior trauma, and so forth) ,this may impact the tissue quality needed for reconstruction can affect your candidacy for all genital gender affirming surgery (phalloplasies, vulvoplasty, etc.This is why it’s VERY important to let your doctor know if you notice any changes in your IBD or discomfort so you can have achieve your transition related goals!
Close communication between your gastroenterologist, colorectal and gender-affirming surgeon, and radiologists is critical. Please do not ever feel hesitant to speak up if you feel something is not your 'normal'. This is not to be doom and gloom!! Many transgender people with IBD have had successful gender-affirming surgery - it is just VERY IMPORTANT that you keep all of your doctors and surgeons in the loop.